O'Grady Kerry-Ann F, Grimwood Keith, Sloots Theo P, Whiley David M, Acworth Jason P, Phillips Natalie, Marchant Julie, Goyal Vikas, Chang Anne B
Centre for Children's Health Research, Institute of Health and Biomedical Innovation, Queensland University of Technology, South Brisbane, 4101, Australia.
Menzies Health Institute Queensland, Griffith University and Gold Coast Health, Gold Coast, Australia.
Pediatr Pulmonol. 2017 Mar;52(3):373-381. doi: 10.1002/ppul.23527. Epub 2016 Jul 26.
Cough is symptomatic of a broad range of acute and chronic pediatric respiratory illnesses. No studies in children have tested for an extended panel of upper airway respiratory viruses and bacteria to identify whether they predict cough outcomes, irrespective of clinical diagnosis at the time of acute respiratory illness (ARI). We therefore determined whether upper airway microbes independently predicted hospitalization and persistent cough 28-days later in children presenting with an ARI, including cough as a symptom.
A cohort study of children aged <15-years were followed for 28-days after presenting to a pediatric emergency department with an ARI where cough was also a symptom. Socio-demographic factors, presenting clinical features and a bilateral anterior nasal swab were collected at enrolment. Polymerase chain reaction assays tested for seven respiratory bacteria and 17 viruses. Predictors of hospitalization and persistent cough at day-28 were evaluated in logistic regression models.
Eight hundred and seventeen children were included in the analysis; median age 27.7-months. 116 (14.2%, 95%CI 11.8, 16.6) children were hospitalized and 163 (20.0%, 95%CI 17.2, 22.7) had persistent cough at day-28. Hospitalized children were more likely to have RSV A or B detected on nasal swab than those not admitted (adjusted relative risk (aRR) 1.8, 95%CI 1.0, 3.3). M. catarrhalis was the only microbial difference between children with and without cough persistence (aRR for those with cough at day 28: 2.1, 95%CI 1.3, 3.1).
An etiologic role for M. catarrhalis in the pathogenesis of persistent cough post-ARI is worth exploring, especially given the burden of chronic cough in children and its relationship with chronic lung disease. Pediatr Pulmonol. 2017;52:373-381. © 2016 Wiley Periodicals, Inc.
咳嗽是多种急慢性儿科呼吸道疾病的症状。尚无针对儿童的研究检测过上呼吸道呼吸道病毒和细菌的扩展组，以确定它们是否能预测咳嗽结果，而不考虑急性呼吸道疾病（ARI）发作时的临床诊断。因此，我们确定上呼吸道微生物是否能独立预测ARI患儿28天后的住院情况和持续性咳嗽，咳嗽作为一种症状包含在内。
对年龄小于15岁的儿童进行队列研究，这些儿童因ARI伴咳嗽症状到儿科急诊科就诊后随访28天。入组时收集社会人口统计学因素、临床表现和双侧前鼻拭子。采用聚合酶链反应检测7种呼吸道细菌和17种病毒。在逻辑回归模型中评估第28天住院和持续性咳嗽的预测因素。
817名儿童纳入分析；中位年龄27.7个月。116名（14.2%，95%CI 11.8，16.6）儿童住院，163名（20.0%，95%CI 17.2，22.7）在第28天有持续性咳嗽。与未住院儿童相比，住院儿童鼻拭子检测出呼吸道合胞病毒A或B的可能性更高（调整相对风险（aRR）1.8，95%CI 1.0，3.3）。卡他莫拉菌是有和没有持续性咳嗽儿童之间唯一的微生物差异（第28天有咳嗽儿童的aRR：2.1，95%CI 1.3，3.1）。
卡他莫拉菌在ARI后持续性咳嗽发病机制中的病因作用值得探讨，特别是考虑到儿童慢性咳嗽的负担及其与慢性肺病的关系。《儿科肺科杂志》。2017年；52：373 - 381。©2016威利期刊公司。
